title: [Reversible cerebral vasoconstriction syndrome (RCVS) triggered by nicotine patches].
abstract: We present a case of a patient with reversible cerebral vasoconstriction syndrome (RCVS) triggered by nicotine patches. A-50-year-old woman had no medical history and no regular medication. She smoked 20 cigarettes a day for 30 years. Six days after using nicotine patches, she had recurrent severe headaches of sudden onset (thunderclap headaches). On examination, the blood pressure was 142/88 mmHg. Her neurological and general examination, laboratory serum investigations, and cerebrospinal fluid examination were normal. Magnetic resonance imaging (MRI) including magnetic resonance angiography (MRA) on admission, day 10 after the first episode showed severe multifocal segmental narrowing of the bilateral posterior cerebral artery (PCA). Cessation of nicotine patches and administration of calcium-channel antagonist amlodipine 5 mg daily ameliorated her headache. Follow-up MRA, 37 days after the first episode, showed improvement of PCA stenosis. We diagnosed her as reversible cerebral vasoconstriction syndrome (RCVS) due to nicotine patches. It is important to recognize nicotine patches as a trigger of RCVS.
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hijikata
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Watanabe
authors.forename: Mizuki
authors.initials: M
authors.lastname: Ito
authors.forename: Noritaka
authors.initials: N
authors.lastname: Yoneyama
authors.forename: Naoki
authors.initials: N
authors.lastname: Atsuta
authors.forename: Gen
authors.initials: G
authors.lastname: Sobue
mesh_terms: D002561:Cerebrovascular Disorders / Q000139:chemically induced*; D005260:Female; D051271:Headache Disorders, Secondary / Q000139:chemically induced; D006801:Humans; D008875:Middle Aged; D013577:Syndrome; D061485:Tobacco Use Cessation Devices / Q000009:adverse effects*; D014661:Vasoconstriction